Effect of Midwife-Provided Orientation of Birth Companions on Maternal Anxiety and Coping during Labor: A Stepped Wedge Cluster Randomized Control Trial in Eastern Uganda

Abstract

The study aimed to assess the effect of midwife-provided orientation of birth companions on maternal anxiety and coping during labor. A stepped wedge cluster randomized trial design was conducted among 475 participants (control n = 240), intervention n = 235) from four clusters. Midwives in the intervention period provided an orientation session for the birth companions on supportive labor techniques. Coping was assessed throughout labor and anxiety scores were measured after birth. Independent t-test and Chi-Square tests were used to assess the differences by study period. Anxiety scores were reduced among women in the intervention period (p = 0.001). The proportion of women able to cope during early active labor was higher during the intervention period (p = 0.031). Women in the intervention period had 80% higher odds of coping (p = 0.032) compared to those in the control period. Notable differences in anxiety and coping with labor were observed among first-time mothers, younger women, and when siblings provided support. Midwife-provided orientation of birth companions on labor support lowers maternal anxiety and improves coping during labor. Findings could inform the planning and development of policies for the implementation of the presence of birth companions in similar low-resource settings.

Efficacy of midwife-led role orientation of birth companions on maternal satisfaction and birth outcomes: a randomized control trial in Uganda

“…Women who had a birth companion, in spontaneously established labor and expecting a vaginal delivery were included. Exclusion criteria were women with multiple pregnancies, previous cesarean section, with mental illness, deaf or mute [ 16 ].…”

“…Each task was explained in simple terms, including why the task was important and how it was performed, then companions were shown how it was performed, with return demonstrations from the companion. This was repeated for the birth companion to grasp and retain the task [ 16 ].…”

“…The first author (EWW) pilot tested the tool for reliability and integrated learnings in the tool. Maternal satisfaction was assessed by research assistants after birth on the morning of discharge at the postnatal unit [ 16 ].…”

Birth attendants’ attitudes and practice of companionship during facility-based childbirth and associated factors in the West Shoa Zone, central Ethiopia: A mixed method design

“… 7 , 9 Furthermore, women also get psychological and emotional support, which soothes pain and loneliness, strengthens family bonds, and helps in the physiological progression of labor and delivery. 10 – 12 …”

“…7,9 Furthermore, women also get psychological and emotional support, which soothes pain and loneliness, strengthens family bonds, and helps in the physiological progression of labor and delivery. [10][11][12] Evidence shows that allowing companionship during labor and delivery improves the process of normal labor and birth and, hence, increases the likelihood of spontaneous vaginal birth and reduces the likelihood of operative delivery, including the cesarean section, compared with a setting in which companionship is not allowed. In addition, it reduces the duration of labor and the likelihood of having a baby with a low 5-min Apgar score.…”